Undergraduate nursing simulation facilitators lived experience of facilitating reflection-in-action during high-fidelity simulation: A phenomenological study.

BACKGROUND: Reflective practice is an essential step to learning in high-fidelity simulation, yet, reflection-in-action is an often overlooked yet important opportunity to support student learning. OBJECTIVES: To explore and describe the lived experience of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. DESIGN: A descriptive phenomenological study. SETTING: A western Canadian province. PARTICIPANTS: Undergraduate nursing simulation facilitators with experience in nursing education and simulation facilitation. METHODS: We conducted 11 semi-structured interviews and utilized Colaizzi's seven step process of analysis to discover the essence of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. RESULTS: Simulation facilitators were able to identify reflection-in-action during high-fidelity simulation when students paused, collaborated, shared their thinking aloud, and changed their course of action. Barriers to reflection-in-action included learner fear and anxiety, poor simulation design, and inadequately prepared students and facilitators. Simulation facilitators supported reflection-in-action through prebriefing, facilitator curiosity, and providing cue, prompts, and facilitated paused. Some of the noted benefits to reflection-in-action include promoting collaborative learning, building confidence and critical thinking, and embedding reflection into practice. CONCLUSIONS: The insights from this research can be used to guide reflection-in-action strategy development and future research in high-fidelity simulation.

Reflection-in-action during high-fidelity simulation: A concept analysis.

OBJECTIVES: Our primary aim was to complete an in-depth analysis of the concept of "reflection-in-action" during high-fidelity simulation. We sought to identify what is currently known about the topic and establish a strong foundation for theory development regarding cultivating reflection-in-action during high-fidelity simulation. DESIGN: Walker and Avant's (2011) systematic approach to concept analysis was used as a framework to develop a comprehensive understanding of reflection-in-action during high-fidelity simulation. DATA SOURCES: We conducted a review of literature on reflection-in-action (with open date parameters) in PubMed, Eric, PsychInfo, ABI/Business Premium Collection, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) electronic data bases using key terms "reflection-in-action" AND "simulation". In addition, we hand-searched reference lists from key articles in the journals Simulation in Healthcare, Simulation and Gaming, and Advances in Simulation. RESULTS: Our search resulted in 22 articles, from 1998 to 2019, that met the inclusion criteria. Four defining attributes of the concept were identified: (1) reflection-in-action must occur during high-fidelity simulation and cannot be captured within post-simulation debriefing; (2) a critical learning juncture must occur and be identified by the learners; (3) a pause in student action must occur during the high-fidelity simulation; and (4) knowledge sharing must occur through out-loud discussion. Antecedents, consequences, and empirical referents of reflection-in-action were also identified. CONCLUSIONS: The insights from this review may enhance the ability of nursing educators to effectively support reflection-in-action within high-fidelity simulation nursing education. This concept analysis also establishes a foundation for reflection-in-action strategy development, as well as suggestions for future research in high-fidelity simulation nursing education.